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Periodontal probing systems: A review of available equipment
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2 Compendium March 2010—Volume 31, Number 2
Abstract: The periodontal pocket, one of the definitive signs
of periodontal disease, is the most common parameter to be
assessed by dental clinicians. Periodontal probes have been
the instruments most commonly used to locate and measure
these pockets. Regular use of periodontal probes in routine
dental practice facilitates and increases the accuracy of the
making a diagnosis, formulating the treatment, and predict-
ing the outcome of therapy. Advances in the field of peri-
odontal probing have led to the development of probes that
may help reduce errors in determining this parameter used
to define the state of active periodontal disease. One such
advance is the emergence of probes that purportedly assess
periodontal disease activity noninvasively. The selection of a
periodontal probe depends on the type of dental practice: a
general dental practitioner would require first- or second-
generation probes, while academic institutions, researchers,
and specialists generally use third and fourth generation.
The periodontal pocket, one of the definitive signs
of periodontal disease, is the most common pa-
rameter to be assessed by dental clinicians. One
of the more reliable and convenient ways of detecting, meas-
uring, and assessing the status of periodontal disease activity
is through the use of periodontal probes. Periodontal probing
permits dentists to identify sites with a history of periodontal
disease or those at risk for periodon-
tal breakdown. Described by Orban et
al as the “eye of the operator beneath
the gingival margin,” the use of peri-
odontal probes is an essential part of
a complete dental examination.1
USES OF 
PERIODONTAL PROBES
The word probe is derived from the
Latin word probo, which means “to
test.” Periodontal probes are used pri-
marily to detect and measure periodon-
tal pockets and clinical attachment loss. In addition, they
are used to locate calculus; measure gingival recession, width
of attached gingiva, and size of intraoral lesions; identify
tooth and soft-tissue anomalies; locate and measure furca-
tion involvements; and determine mucogingival relation-
ships and bleeding tendencies.2 However, periodontal prob-
ing has its limitations. Reading errors may result from nat-
urally occurring states, such as interference from the calcu-
lus on the tooth or root surface, the presence of an over-
hanging restoration, or the crown’s contour. Another factor
is operator error, such as incorrect angulation of the probe,
the amount of pressure applied to the probe, misreading
the probe, recording the data imprecisely, and miscalculat-
ing the attachment loss.3
Various factors, such as probe-tip size, angle of insertion
of the probe, probing pressure, precision of probe calibra-
tion, and degree of inflammation in the underlying peri-
odontal tissues, affect the sensitivity and reproducibility of
measurements.4 Because the probe passes through the junc-
tional epithelium into the underlying connective tissue in an
inflamed gingival sulcus, readings of clinical pocket depth
obtained with the periodontal probes do not normally coin-
cide with the measurements up to the base of the pocket.4
The National Institute for Dental and Craniofacial Re-
search (NIDCR) has defined eight criteria for overcoming
1Senior Lecturer, Department of Periodontology, Kanti Devi Dental College and Hospital, Mathura-Delhi, Uttar Pradesh, India
2Professor and Head, Vice Principal, Department of Periodontology and Implantology, Bapuji Dental College and Hospital, Davangere,
Karnataka, India
3Senior Lecturer, Department of Community Dentistry, Kanti Devi Dental College and Hospital, Mathura-Delhi, Uttar Pradesh, India
4Senior Lecturer, Department of Periodontology, Kanti Devi Dental College and Hospital, Mathura-Delhi, Uttar Pradesh, India
5Reader, Department of Periodontology, Kanti Devi Dental College and Hospital, Mathura-Delhi, Uttar Pradesh, India
Periodontal Probing
Systems: A Review of
Available Equipment
Srinivas Sulugodu Ramachandra, MDS;1
Dhoom Singh Mehta, MDS, FADI, FISOI, FICD;2
Nagarajappa Sandesh, MDS;3 Vidya Baliga, MDS;4
and Janardhan Amarnath, MDS5
Practical Applications
 
the limitations of conventional periodontal probing.5 Table 1
shows how the NIDCR has altered conventional probing
criteria to meet this objective. 
PERIODONTAL PROBE SELECTION 
AND TYPE OF DENTAL PRACTICE
For consistency of use and academic purposes, in 1992, Pihl-
strom et al6 classified probes into three generations. In 2000,
Watts7 extended this classification by adding fourth- and fifth-
generation probes. These generations, along with their advan-
tages and disadvantages, are presented in Table 2.
Various periodontal probes cater to different needs. Se-
lecting the appropriateperiodontal probe is dependent on
the type of dentistry. The needs of a general dentist are
different from those of a periodontist who usually requires
a more specialized set of periodontal probes. Research
facilities and academic institutions can afford and effec-
tively use more complex and sophisticated periodontal
probes. Also, because the latest generations of probes work
in conjunction with computers, the state of computeriza-
tion in a dental practice has to be considered during the
selection process.
1. Periodontal probes suitable for a general dental practice:
a. First generation
b. Second generation
2. Periodontal probes suitable for a dental practice with
an interest in periodontics:
a. First generation
b. Second generation
c. Third generation (if computerization is adequate)
3. Periodontal probes suitable for a specialty periodontal
practice and university and research institutions:
a. First generation
b. Second generation
c. Third generation
d. Fifth generation
PERIODONTAL PROBE GENERATIONS
First Generation (Conventional)
Conventional or manual probes (Figure 1) do not control
for probing pressure and are not suited for automatic data
collection. These probes most commonly are used by gen-
eral dental practitioners and periodontists.
Invented in 1936 by periodontist Charles H.M. Williams,
the Williams’ periodontal probe is the prototype or benchmark
for all first-generation probes. These probes have a thin stain-
less steel tip of 13 mm in length and a blunt tip end with a di-
ameter of 1 mm. The graduations on these probes are 1 mm,
2 mm, 3 mm, 5 mm, 7 mm, 8 mm, 9 mm, and 10 mm. (The
4-mm and 6-mm markings are absent to improve visibility
and avoid confusion in reading the markings.) The probe tips
and handles are enclosed at 130º.8
The Community Periodontal Index of Treatment Needs
(CPITN) was designed by George S. Beagrie and Jukka
Ainamo in 1978. CPITN probes are recommended for use
when screening and monitoring patients with the CPITN
index. The index and its probes were first described in the
World Health Organization’s (WHO) Epidemiology, etiol-
ogy, and prevention of periodontal diseases. Report of a WHO
Scientific Group.9 The FDI World Dental Federation/WHO
Joint Working Group 1 has advised the manufacturers of
CPITN probes to identify the instruments as CPITN-E (epi-
demiologic), which have 3.5-mm and 5.5-mm markings, and
CPITN-C (clinical), which have 3.5-mm, 5.5-mm, 8.5-mm,
and 11.5-mm markings. CPITN probes have thin handles
and are lightweight (5 gm). The probes have a ball tip of
0.5 mm, with a black band between 3.5 mm and 5.5 mm,
as well as black rings at 8.5 mm and 11.5 mm.
University of Michigan O probes have markings at 3 mm,
6 mm, and 8 mm. A modification of this probe with Will-
iams’ markings also is available.
University of North Carolina-15 (UNC-15) probes are
color-coded at every millimeter demarcation. They are the
preferred probe in clinical research if conventional probes
are required.
www.compendiumlive.com Compendium 3
Ramachandra et al
Limitation Conventional NIDCR Criteria
Precision 1.0 mm 0.1 mm
Range 12.0 mm 10.0 mm
Probing force Nonstandardized Constant
Applicability Noninvasive Noninvasive
Reach Easy to access Easy to access
Angulation Subjective Guidance system
Readout Voice dictation Direct 
and recording electronic reading
Security Easily sterilized Complete sterilization
Table 1: National Institute for Dental 
and Craniofacial Research (NIDCR) Criteria
4 Compendium March 2010—Volume 31, Number 2
Practical Applications
Table 2: Advantages and Disadvantages of Periodontal Probe Generations 
FIRST GENERATION: Williams’, CPITN, UNC-15, University of Michigan O, Goldman-Fox, 
Glickman, Merritt A and B, Nabers
Advantages Disadvantages
• Easily available and inexpensive
• Tactile sensitivity is preserved
• Even in presence of subgingival calculus, probe can 
be inserted with little navigation by the operator
• Tip is rounded to avoid tissue trauma
• Color-coded for easier and faster identiÞcation 
of readings
• Heavy
• Probing force is not controlled so the tip of the probe 
may pass beyond the base of the pocket
• Errors during visualizing the readings are possible
• An assistant is needed to transfer the readings to 
the chart
SECOND GENERATION: True Pressure Sensitive, Yeaple
Advantages Disadvantages
• Standardization of probing forces
• Comfortable to the patient
• Constant pressure
• Probe tip may pass beyond the junctional epithelium in
inßamed sites
• Reading has to be performed manually, and an assistant
is needed to record the same on the patient chart
• No computerized storage of data
THIRD GENERATION: Toronto Automated, Florida Probe, InterProbe, Foster-Miller
Advantages Disadvantages
• Standardization of probing forces
• Errors in reading the probe and transferring the 
data are eliminated.
• Printout of the data from the computer can be used 
for patient education
• Tactile sensitivity is decreased
• Probe may pass beyond the junctional epithelium in
inßamed sites, overestimating the pocket depth
• After the inßammation has resolved, probe may not 
penetrate beyond the long junctional epithelium, leading 
to underestimation of the pocket depth
FOURTH GENERATION:
Advantages Disadvantages
• Three-dimensional probe
• Sequential probe positions are measured
• Under development
• Invasive 
FIFTH GENERATION: UltraSonographic 
Advantages: Disadvantages:
• A noninvasive probe that provides painless probing
to the patient
• There is no question of probe passing beyond the
junctional epithelium, as ultrasound waves detect, image,
and map the upper boundary of periodontal ligament
• Computerized storage of data and printout or visuals 
can be used for patient education
• Guidance path is predetermined
• Provides information regarding condition of the 
gingival tissues
• Expensive
• Operator needs to understand the images provided by the
computer
• Requires a learning curve
The Nabers probe is used to detect and measure the in-
volvement of furcal areas by the periodontal disease process
in multirooted teeth. Nabers probe also is used in the assess-
ment of more complex clinical cases, including those with
a restorative treatment. These probes can be color-coded or
without demarcation.
Second Generation (Constant-Pressure) 
The second-generation instruments are pressure sensitive,
allowing for improved standardization of probing pressure.
Scientific literature that demonstrated probing pressure should
be standardized and not exceed 0.2 N/mm2 led to the devel-
opment of these probes.10 Second-generation probes can be
used in general dental practices, as well as periodontal prac-
tices, and do not require computerization in the dental office.
The True Pressure Sensitive (TPS) probe (Figure 2) is
the prototype for second-generation probes. Introduced by
Hunter in 1994, these probes have a disposable probing head
and a hemispheric probe tip with a diameter of 0.5 mm. A
controlled probing pressure of 20 gm is usually applied.
These probes have a visual guide and a sliding scale where
two indicator lines meet at a specified pressure.11
In 1977, Armitage et al designed a pressure-sensitive probe
holder to standardize the insertion pressure and determine
how accurate probing pressure of 25 pounds affected the
connective-tissue attachment.12 In 1978, van der Velden and
de Vies devised a pressure-sensitive probe with a cylinder
and piston connected to an air-pressure system. Subsequent-
ly, it was modified with a displacement transducer for elec-
tronic pocket-depth reading.13
The electronic pressure-sensitive probe, allowing for con-
trol of insertion pressure, was introduced by Polson in 1980.
This probe has a handpiece and a control base that allows
the examiner to control the probing pressure. The pressure is
increased until an audio signal indicates that the preset pres-
sure has been reached.14 Polson et al’s original design was mod-
ified by its initial users: that probe isknown as the Yeaple
probe, which is used in studies of dentinal hypersensitivity.15
Third Generation (Automated)
In spite of the advances in second-generation probes, other
sources of errors, such as in reading the probe, recording
data, and calculating attachment level, remained unad-
dressed. Third-generation probes were developed to help
minimize these mistakes by using not only standardized
pressure but also digital readouts of the probes’ readings
and computerized data storage. This generation includes
computer-assisted direct data capture to reduce examiner
bias and allows for greater probe precision. These probes
require computerization of the dental office and can be
used by periodontists and academic institutions for research.
The Foster-Miller probe (Foster-Miller, Inc, www.foster-
miller.com) is the prototype of third-generation probes.
Devised by Jeffcoat et al16 in 1986, this probe has con-
trolled probing pressure and automated detection of the
cementoenamel junction (CEJ). The components of the
probe are: a pneumatic cylinder, linear variable differen-
tial transducer (LVDT), force transducer, accelerator, and
probe tip.
The main mechanism of action of the Foster-Miller probe
is by detection of the CEJ (Figure 3 and Figure 4). The ball
tip moves or glides over the root surface at a controlled speed
and preset pressure. Abrupt changes in the acceleration of
the probe movement (recorded on a graph) indicate when it
meets the CEJ and when it is stopped at the base of the pocket.
Under controlled pressure, the probe tip is extended into
www.compendiumlive.com Compendium 5
Ramachandra et al
Figure 1 First-generation periodontal probes (left to right):
Williams’ Graduated, CPITN, UNC-15, Goldman-Fox, Nabers.
Figure 2 The True Pressure Sensitive Probe, a second-
generation periodontal probe. The indicator lines meet at 
a specified force of 20 gm.
the pocket and refracted automatically when the base of the
pocket is reached. Position and acceleration-time histories
are analyzed to determine attachment level and pocket depth.
As with all devices, the Foster-Miller probe has advantages
and disadvantages. The main advantage is the automatic
detection of the CEJ, which is a better landmark than gin-
gival margin, because the position of the gingival margin
may change depending on inflammation or recession.17 The
main disadvantage is that it can deem root roughness or root
surface irregularities as the CEJ.16
The Florida Probe® (Florida Probe Corp, www.florida
probe.com) was devised by Gibbs et al18 in 1988 (Figure 5).
This probe consists of a handpiece and sleeve, displacement
transducer, foot switch, and computerized interface/per-
sonal computer. The hemispheric probe tip has a diameter
of 0.45 mm, and the sleeve has a diameter of 0.97 mm (Fig-
ure 6). Constant probing pressure of 15 gm is provided by
coil springs inside the handpiece. The edge of the sleeve is
the reference from which measurements are made, and the
probe has Williams’ markings; however, actual measure-
ment of the pocket depth is made electronically and trans-
ferred automatically to the computer when the foot switch
is pressed (Figure 7).
These probes provide a constant probing pressure of
15 gm, which can be overridden when necessary, for accura-
cy and patient comfort. They also can record missing teeth,
recession, pocket depth, bleeding, suppuration, furcation
involvement, mobility, and plaque assessment.19 Each meas-
urement is recorded with potentially 0.2-mm accuracy.
Comparison to previous data can be made more quickly and
accurately. (The system shows black arrows for changes be-
tween 1 mm and 2 mm, and red arrows are used for changes
> 2 mm.) Also, diseased sites are shown on a chart, which
can be used in patient education.19 The Florida Probe does
have some disadvantages, which include underestimating
of deep probing depth and a lack of tactile sensitivity. Also,
clinicians need to be trained to operate these probes.20
The Toronto Automated probe, devised by McCulloch
and Birek in 1991 at the University of Toronto, used the oc-
clusoincisal surface to measure relative clinical attachment
levels.21 The sulcus is probed with a 0.5-mm nickel-titanium
wire that is extended under air pressure. It controls angular
discrepancies by means of a mercury tilt sensor that limits
angulation within ± 30º. This probe has the advantage of
an incorporated electronic guidance system to improve
precision in probe angulation. It also estimates the bio-
physical integrity of the dentogingival junction by measur-
ing intrapocket probing velocity.22 The disadvantages are
associated with positioning: it is difficult to measure sec-
ond and third molars, and patients have to position their
heads in the same place to reproduce readings.23
The InterProbe™ (The Dental, Probe Inc, www.interprobe.
com), also known as the Perio Probe, is a third-generation
probe with a flexible probe tip, which curves with the tooth
as the probes enters the pocket area.17 Stainless steel probes
push the gingiva away from the tooth, causing pain, whereas
the InterProbe gently slides in. This probe produces accu-
rate readings of periodontal pockets with its standardized
6 Compendium March 2010—Volume 31, Number 2
Practical Applications
Figure 3 Schematic representation of various parts of the
Foster-Miller probe, a third-generation periodontal probe. 
Figure 4 Schematic representation of mechanism of action of
Foster-Miller probe. When the ball tip is moved across the root
surface, a “catch” is detected at the CEJ.
Figure 5 The Florida Probe, a third-generation periodontal
probe (photograph courtesy of Florida Probe Corporation).
LVDT = linear variable differential transducer; FTA = force
transducer accelerator.
15 gm of pressure. The probe’s optical encoder handpieces
uses constant probing pressure, which provides repeatable
measurement of pocket depth and attachment loss.
Fourth Generation 
Fourth-generation refers to three-dimensional (3D) probes.
Currently under development, these probes are aimed at
recording sequential probe positions along the gingival sul-
cus. They are an attempt to extend linear probing in a se-
rial manner to take into account the 3D pocket being
examined.7
Fifth Generation 
Despite all the advances in earlier generation probes, they
remain invasive and, at times, their use can be painful to pa-
tients. Plus, with these earlier generation probes, the probe
tip usually crosses the junctional epithelium. Fifth-generation
probes are being devised to eliminate these disadvantages.
Probes are being designed to be 3D and noninvasive: an
ultrasound or other device is added to a fourth-generation
probe. Fifth-generation probes aim to identify the attach-
ment level without penetrating it.
The only fifth-generation probe available, the UltraSono-
graphic (US) probe (Visual Programs, Inc, www.usprobe.
com), uses ultrasound waves to detect, image, and map the
upper boundary of the periodontal ligament and its varia-
tion over time as an indicator of the presence of periodontal
disease. The US probe was devised by Hinders and Compan-
ion at the NASA Langley Research Center.24 This small in-
traoral probe has an ultrasound beam projection area close
enough in size to the width of the periodontal ligament space
to give the optimal coupling and small enough to inspect the
area between the teeth, while still delivering sufficient sig-
nal strength and depth of penetration to image the peri-
odontal ligament space. To probe these structures ultra-
sonically, a narrow beam of ultrasonic energy is projected
down between the tooth and bone from a transducer, which
is scanned manually along the gingival margin.
The transducer is mounted at the base of a dual-taper,
convergent-divergent coupler to provide an acoustically ta-
pered interface with a throat area on the order of 0.5 mm.
This constitutes an active area reduction from the trans-
ducer element to the aperture of 20:1. Such a reduction is
mandated by the geometryand the very small window af-
forded by the gingival margin. An added virtue of attaining
this small a tip size is the ability of the ultrasonic probe to
help the clinician examine the area between the teeth, which
is where periodontal disease is most likely to occur.
Figure 8 and Figure 9 show how the ultrasound transduc-
er is mounted in the probe-tip shell, which also incorporates
a slight flow of water to ensure good coupling of the ultrason-
ic energy to the tissues. The couplet water can come either
from a suspended intravenous-type sterile bag or plumbed
from the dental-unit water source. The focused ultrasonic
beam is transmitted into the pocket in the same orientation
as the insertion of a manual probe. Then, the probe is moved
along the gingival margin, so the two-dimensional graphical
output corresponds to the results a clinician gets from “walk-
ing the sulcus” with a manual probe. However, ultrasound
gives more information because secondary echoes are rec-
orded from tissue features at various depths. It appears
likely that the technique also will be able to provide infor-
mation on the condition of the gingival tissue and the qual-
ity and extent of the epithelial attachment to the tooth
surface. This may supply valuable data to aid the clinician
in the diagnosis and treatment of these diseases.25
www.compendiumlive.com Compendium 7
Ramachandra et al
Figure 6 The Florida Probe with tip and sleeve diameter
(photograph courtesy of Florida Probe Corporation).
Figure 7 The Florida Probe in use (photograph courtesy of
Florida Probe Corporation).
NONPERIODONTAL PROBES
Calculus Detection
Calculus detection probes detect subgingival calculus by
means of audio readings and are reported to increase chances
of subgingival calculus detection.26 Currently, the DetecTar
probe (DENTSPLY Professional, www.dentsply.com) is the
only calculus detection probe on the market. This device has
a lightweight, well-balanced handpiece, which can be auto-
claved, and it produces an audible beep to signify calculus
detection (beep function can be disengaged). This probe may
augment standard methods of calculus detection; however,
it is expensive and the handpiece is bulkier than a standard
periodontal probe. The probe has a short waterline hookup,
which may prevent ergonomic placement of the unit, and it
does not have a published waterline treatment protocol. As
with many automated probes, there is potential for false posi-
tives and false negatives; therefore, further research is required.
Periodontal Disease Evaluation System
The Diamond Probe®/Perio 2000® System (Diamond General
Development Corp, www.diamondgeneral.com) reportedly
detects periodontal disease during routine dental examina-
tions by measuring relative sulfide concentrations as an indi-
cator of gram-negative bacterial activity. The system consists
of a single-use disposable probe tip with microsensors con-
nected to a main control unit.27 The probe might detect
periodontal disease at an early stage and might find an active
site that requires treatment. However, the probing pressure
is not controlled. Also, periodontal disease can be caused
by bacteria that do not produce volatile sulphur compounds,
creating the potential for some disease activity to be missed.28
The Periotemp® Probe (Abiodent Inc) is a temperature-
sensitive probe, which reportedly detects early inflammatory
changes in the gingival tissues by measuring temperature
variations in these tissues.29 The Periotemp Probe detects
pocket temperature differences of 0.1ºC from a referenced
subgingival temperature.30 This probe has two light-indicating
diodes: red-emitting diode, which indicates higher temper-
ature, denoting risk is twice as likely for future attachment
loss; and green-emitting diode, which indicates a lower tem-
perature, indicating lower risk. This probe can detect initial
inflammatory changes; therefore, treatment can be initiated
at an early stage.30 However, the presence of surface cooling
caused by breath airflow may further complicate the deter-
mination of even a normal temperature distribution.31
CONCLUSION
Newer developments in the field of periodontal probes
provide the potential for error-free determination of pocket
depth and clinical attachment level at a very early stage.
Earlier screening for periodontal disease is gaining impor-
tance because of the association with systemic conditions.
With more research and innovation, the advent of newer
error-free probes may resolve the remaining problems and
those yet to be realized.
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2. Esther M Wilkins. Examination procedures. In: Wilkins EM.
Clinical Practice of the Dental Hygienist. 9th ed. Philadelphia,
PA: Lippincott Williams and Wilkins; 2005:222-245.
3. Badersten A, Nilvéus R, Egelberg J. Reproducibility of prob-
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8 Compendium March 2010—Volume 31, Number 2
Practical Applications
Figure 8 The various parts of US periodontal probe (photograph
courtesy of Mark Hinders, Applied Science Department,
College of William and Mary, Williamsburg, Virginia).
Figure 9 The required accessories for using the US periodon-
tal probe (photograph courtesy of Mark Hinders, 
Applied Science Department, College of William and Mary,
Williamsburg, Virginia).
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